Ga-NOTA-Aca-BBN(7-14) 用于儿童视神经胶质瘤中 GRPR 的 PET 成像。
Ga-NOTA-Aca-BBN(7-14) PET imaging of GRPR in children with optic pathway glioma.
机构信息
Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Science and PUMC, Beijing, 100730, China.
出版信息
Eur J Nucl Med Mol Imaging. 2019 Sep;46(10):2152-2162. doi: 10.1007/s00259-019-04392-7. Epub 2019 Jul 3.
PURPOSE
Optic pathway glioma (OPG) is a rare neoplasm that arises predominantly during childhood. Its location in a sensitive region involving the optic pathways, onset in young patients and controversial therapy choice make the management of OPG a challenge in paediatric neuro-oncology. In this study we assessed gastrin-releasing peptide receptor (GRPR)-targeted positron emission tomography (PET) imaging in children with OPG, and the application of a PET/MRI imaging-guided surgery navigation platform.
METHODS
Eight children (five boys, mean age 8.81 years, range 5-14 years) with suspicion of optic pathway glioma on MRI were recruited. Written informed consent was obtained from all patients and legal guardians. Brain PET/CT or PET/MRI acquisitions were performed 30 min after intravenous injection of 1.85 MBq/kg body weight of Ga-NOTA-Aca-BBN(7-14). Four patients also underwent F-FDG brain PET/CT for comparison. All patients underwent surgical resection within 1 week.
RESULTS
All 11 lesions (100%) in the eight patients showed prominent Ga-NOTA-Aca-BBN(7-14) uptake with excellent contrast in relation to surrounding normal brain tissue. Tumour-to-background ratios (SUVmax and SUVmean) were significantly higher for Ga-NOTA-Aca-BBN(7-14) than for F-FDG (28.4 ± 5.59 vs. 0.47 ± 0.11 and 18.3 ± 4.99 vs. 0.35 ± 0.07, respectively). Fusion images for tumour delineation were obtained in all patients using the PET/MRI navigation platform. All lesions were pathologically confirmed as OPGs with positive GRPR expression, and 75% were pilocytic astrocytoma WHO grade I and 25% were diffuse astrocytoma WHO grade II. There was a positive correlation between the SUV of Ga-NOTA-Aca-BBN(7-14) and the expression level of GRPR (r = 0.56, P < 0.01, for SUVmax; r = 0.47, P < 0.05, for SUVmean).
CONCLUSION
This prospective study showed the feasibility of Ga-NOTA-Aca-BBN(7-14) PET in children with OPG for tumour detection and localization. Ga-NOTA-Aca-BBN(7-14) PET/MRI may be helpful for assisting surgery planning in OPG patients with severe symptoms, GRPR-targeted PET has the potential to provide imaging guidance for further GRPR-targeted therapy in patients with OPG.
目的
视神经胶质瘤（OPG）是一种罕见的肿瘤，主要发生在儿童时期。由于其位于涉及视神经的敏感区域，发病于年轻患者，以及治疗选择存在争议，使得儿童神经肿瘤科在治疗 OPG 时面临挑战。本研究评估了胃泌素释放肽受体（GRPR）靶向正电子发射断层扫描（PET）成像在 OPG 儿童中的应用，并评估了 PET/MRI 成像引导手术导航平台的应用。
方法
本研究纳入了 8 名 MRI 怀疑患有视神经胶质瘤的儿童（5 名男性，平均年龄 8.81 岁，范围 5-14 岁）。所有患者及其法定监护人均签署了书面知情同意书。静脉注射 1.85MBq/kg 体重的 Ga-NOTA-Aca-BBN(7-14)后 30 分钟进行脑 PET/CT 或 PET/MRI 采集。4 名患者还进行了 F-FDG 脑 PET/CT 检查以作比较。所有患者均在 1 周内接受了手术切除。
结果
8 名患者的 11 个病灶（100%）均显示出 Ga-NOTA-Aca-BBN(7-14)摄取明显增加，与周围正常脑组织形成良好对比。Ga-NOTA-Aca-BBN(7-14)的肿瘤与背景比值（SUVmax 和 SUVmean）明显高于 F-FDG（28.4±5.59 比 0.47±0.11 和 18.3±4.99 比 0.35±0.07）。所有患者均使用 PET/MRI 导航平台获得了肿瘤勾画的融合图像。所有病变均经病理证实为 OPG，其中 75%为毛细胞型星形细胞瘤 WHO 分级 I 级，25%为弥漫性星形细胞瘤 WHO 分级 II 级。Ga-NOTA-Aca-BBN(7-14)的 SUV 与 GRPR 表达水平呈正相关（SUVmax：r=0.56，P<0.01；SUVmean：r=0.47，P<0.05）。
结论
本前瞻性研究表明，Ga-NOTA-Aca-BBN(7-14) PET 对儿童 OPG 具有肿瘤检测和定位的可行性。Ga-NOTA-Aca-BBN(7-14) PET/MRI 可能有助于为严重症状的 OPG 患者的手术计划提供帮助，GRPR 靶向 PET 有可能为 OPG 患者的进一步 GRPR 靶向治疗提供影像学指导。
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